[伴有手背伸肌腱损伤的皮肤和软组织缺损修复手术后早期康复治疗的临床效果]。

C. Zhu, L. He, T He, Y. Liang, B W Zhang, H. Y. Zhao, H. Guan, X K Yang, D. H. Hu, J. T. Han, J Q Liu
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According to different intervention time for postoperative rehabilitation treatment of patients, the patients were divided into conventional rehabilitation group and early rehabilitation group, with 12 cases in each group. Patients in early rehabilitation group received rehabilitation treatment immediately after surgery under the rehabilitation guidance of specialized rehabilitation physicians based on the characteristics of different postoperative periods. Patients in conventional rehabilitation group began rehabilitation treatment from the third week after surgery, and their rehabilitation treatment was the same as that of patients in early rehabilitation group from the second week after surgery. The patients in 2 groups were treated in the hospital until the sixth week after surgery. The occurrence of flap vascular crisis and tendon rupture were observed within 6 weeks after surgery. 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引用次数: 0

摘要

目的探讨伴有手背伸肌腱损伤的皮肤和软组织缺损修复手术后早期康复治疗的临床效果。研究方法本研究为回顾性非随机对照研究。2015年2月至2023年2月,空军军医大学第一附属医院收治了24例手背皮肤软组织缺损伴伸肌腱损伤的患者(男15例,女9例,年龄12-55岁),均符合纳入标准,并进行了皮瓣移植和肌腱移植或肌腱吻合修复。根据患者术后康复治疗干预时间的不同,将患者分为常规康复组和早期康复组,每组12例。早期康复组患者根据术后不同时期的特点,术后立即在专业康复医师的康复指导下接受康复治疗。常规康复组患者从术后第三周开始接受康复治疗,术后第二周开始接受与早期康复组相同的康复治疗。两组患者均在医院接受治疗至术后第六周。术后 6 周内观察到皮瓣血管危象和肌腱断裂的发生。术后6周后,采用徒手肌肉测试法测量患手的食指与拇指间捏合力、侧捏合力、三点捏合力和握力;采用全动作运动法评估患手的手指关节活动范围,并计算优、良比例;采用卡罗尔上肢功能测试法对患手的功能进行评分和评级。结果术后6周内,常规康复组仅有1例患者出现静脉危象,经二次手术探查并吻合血管后皮瓣存活;两组患者均未发生肌腱断裂。手术 6 周后,两组患者的食指与拇指间捏合力、患侧捏合力、三点捏合力、患手握力差异无统计学意义(P>0.05);早期康复组患者患手手指关节活动范围优、良比为 11/12,高于常规康复组的 7/12,但差异无统计学意义(P>0.05);早期康复组患者的患手功能评分为(90±6)分,明显高于常规康复组的(83±8)分(t=2.41,P<0.05);早期康复组患者的患手功能评分明显优于常规康复组(Z=2.04,P<0.05)。结论对手背皮肤软组织缺损伴伸肌腱损伤修复术后患者进行早期康复治疗,可改善手部功能,且不会增加手术相关并发症,值得临床推广应用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand].
Objective: To explore the clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand. Methods: This study was a retrospective non-randomized controlled study. From February 2015 to February 2023, 24 patients (15 males and 9 females, aged 12-55 years) with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand, who met the inclusion criteria and were repaired with flap transplantation and tendon grafting or tendon anastomosis, were admitted to the First Affiliated Hospital of Air Force Medical University. According to different intervention time for postoperative rehabilitation treatment of patients, the patients were divided into conventional rehabilitation group and early rehabilitation group, with 12 cases in each group. Patients in early rehabilitation group received rehabilitation treatment immediately after surgery under the rehabilitation guidance of specialized rehabilitation physicians based on the characteristics of different postoperative periods. Patients in conventional rehabilitation group began rehabilitation treatment from the third week after surgery, and their rehabilitation treatment was the same as that of patients in early rehabilitation group from the second week after surgery. The patients in 2 groups were treated in the hospital until the sixth week after surgery. The occurrence of flap vascular crisis and tendon rupture were observed within 6 weeks after surgery. After 6 weeks of surgery, the manual muscle test was used to measure the pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, and grip force of the affected hand; the total action motion method was used to evaluate the finger joint range of motion of the affected hand, and the excellent and good ratio was calculated; the Carroll upper extremity function test was used to score and rate the function of the affected hand. Results: Within 6 weeks after surgery, only 1 patient in conventional rehabilitation group suffered from venous crisis, and the flap survived after the second surgical exploration and anastomosis of blood vessels; there was no occurrence of tendon rupture in patients of 2 groups. After 6 weeks of surgery, there were no statistically significant differences in pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, or grip force of the affected hand between the two groups of patients (P>0.05); the excellent and good ratio of the finger joint range of motion of the affected hand of patients in early rehabilitation group was 11/12, which was higher than 7/12 in conventional rehabilitation group, but there was no statistically significant difference (P>0.05); the affected hand function score of patients in early rehabilitation group was 90±6, which was significantly higher than 83±8 in conventional rehabilitation group (t=2.41, P<0.05); the function rating of the affected hand of patients in early rehabilitation group was obviously better than that in conventional rehabilitation group (Z=2.04, P<0.05). Conclusions: Early rehabilitation treatment for patients with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand after repair surgery can improve hand function, but it would not increase surgery related complications, which is worthy of clinical promotion and application.
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